Overview
The Decision at the Bedside
Most headaches are not caused by a dangerous intracranial process, but pain intensity alone cannot establish that a headache is benign.
Most headaches are not caused by a dangerous intracranial process, but pain intensity alone cannot establish that a headache is benign. The first clinical question is whether the presentation fits the person’s established migraine pattern or whether something about the onset, trajectory, examination, or context suggests a secondary headache. Migraine is a recurrent primary headache syndrome. A red-flag headache is not a diagnosis; it is a warning pattern that may represent subarachnoid haemorrhage, infection, raised intracranial pressure, tumour, vascular disease, or traumatic bleeding. The nurse does not need to identify the exact secondary cause before acting. The nurse does need to recognise when routine migraine treatment is no longer the safest first step. Experienced clinicians listen for the story before focusing on the pain score: - Did the pain reach maximum intensity suddenly? - Is this the first headache of this type, or is it clearly different from previous attacks? - Is the pattern progressively worsening? - Is there a focal neurological change, seizure, altered level of consciousness, papilledema, fever, or neck stiffness? - Is there a relevant context such...